Differentiated thyroid cancer: A retrospective evaluation of the impact of changes to disease management guidelines on patients in South East Scotland

Williamson, A.; Wilmot, Victoria; Ntala, Chara; Gibb, Fraser; Conn, Brendan; Nixon, Iain J.

doi:10.1016/j.ejso.2017.10.018

Cited by 3 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to the patient who underwent total thyroidectomy, adjuvant RAI will require a readmission for completion thyroidectomy. It has been well demonstrated that this procedure rarely, if ever, results in additional primary disease risk factors being identified other than previously occult small volume multifocal disease [94,95]. Therefore, clinicians should recognise that this procedure is only performed to facilitate RAI.…”

Section: Radioactive Iodine and The Surgeonmentioning

confidence: 99%

The role of radioactive iodine in the management of patients with differentiated thyroid cancer – An oncologic surgical perspective

Nixon

Shah

Zafereo

et al. 2020

European Journal of Surgical Oncology

View full text Add to dashboard Cite

With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects.This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.

show abstract

Section: Radioactive Iodine and The Surgeonmentioning

confidence: 99%

The role of radioactive iodine in the management of patients with differentiated thyroid cancer – An oncologic surgical perspective

Nixon

Shah

Zafereo

et al. 2020

European Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…For example, Ibrahim et al found that multiple foci in the initial specimen formed the only variable independently associated with bilateral disease 39 . However, subsequent reports have shown that the contralateral lobe rarely contains high‐risk disease if the ipsilateral lobe has multicentric disease 40,41 . While the prognostic importance of multicentric PTC may be controversial, 42 strong consideration should be given to performing a total thyroidectomy when the multicentric nodules are larger than 1 cm 43 …”

Section: Decision‐making Process In the Staged Thyroidectomy Approachmentioning

confidence: 99%

Case for staged thyroidectomy

et al. 2020

View full text Add to dashboard Cite

Recent modifications in the management of well‐differentiated thyroid cancer have resulted in significant alterations in clinical approach. Utilizing a series of preoperative and postoperative risk factors involving both the patient and the disease pathology, we offer the term “staged thyroidectomy” to help organize these risk factors for patients and the endocrine team to optimize management. This approach is intended to incorporate our latest nuanced understanding of certain endocrine pathology and may serve to optimize patient outcomes.

show abstract

“…Whilst guideline resources are valuable, it is important to recognise that these are not prescriptive nor comprehensive and that variation might be necessary based on logistic and clinical factors. Adherence to guidelines based on outcome recommendations by MDTs is a topic that has been extensively investigated [ 2 , 7 , 8 , 9 ]. Obviously, adherence to guidelines alone does not necessarily indicate a successful MDT process; it does, though, represent an attempt to standardise the process, reduce errors, and monitor variation in practices [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are many factors which can affect the MDT decision-making process, including the membership, the quality of radiology and pathology resources, time restraints, and the availability of all the relevant clinical information [ 2 , 4 , 7 , 8 ]. It has been shown that, in patients with unifocal papillary thyroid cancer (PTC), pathologic and radiological intra- and inter-observer variability can greatly impact the MDT recommendations [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

Fenton

Wade

Pirrili

et al. 2021

JCM

View full text Add to dashboard Cite

Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.

show abstract

Differentiated thyroid cancer: A retrospective evaluation of the impact of changes to disease management guidelines on patients in South East Scotland

Cited by 3 publications

References 0 publications

The role of radioactive iodine in the management of patients with differentiated thyroid cancer – An oncologic surgical perspective

The role of radioactive iodine in the management of patients with differentiated thyroid cancer – An oncologic surgical perspective

Case for staged thyroidectomy

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

Contact Info

Product

Resources

About